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Systems Analyst Advisor - Claims Platform Modernization

Neumeric Technologies Corporation
Baltimore, MD, United States
3 days ago
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Role details

Contract type
Contract
Employment type
Full-time (> 32 hours)
Working hours
Regular working hours
Job source
www.dice.com

Tech stack

Application Programming Interfaces (APIs) JIRA Batch Processing Business Systems Data Sharing UN Electronic Data Interchange for Administration Commerce and Transport Data Flow Control Python (Programming Language) Webui Requirements Traceability Data Streaming Systems Integration
+8 more
Enterprise Software Applications Cloud Platform System ReactJS Atlassian Tools Enterprise Integration Api Design Restful APIs Mulesoft

Job description

  • Lead current-state analysis of Medicare Part A/Part B business processes, application functions, legacy mainframe interactions, data flows, interfaces, macros and RPA-supported workflows.
  • Conduct stakeholder workshops and document business outcomes, system interactions, upstream/downstream dependencies, exceptions and operational controls.
  • Assess Claims Core native capabilities and supported APIs with technical teams; document retain, modify, consolidate, replace or retire recommendations without assuming one-for-one replacement.
  • Prepare business and functional requirements, user stories, process maps, interface/data requirements, acceptance criteria and traceability to impacted applications and work packages.

  • Work with architects to define future-state workflows, modem web UI needs, API integration scenarios. acceptance criteria and traceability to impacted app cations and work packages.

  • Work with architects to define future-state workflows, modem web UI needs, API integration scenarios and application modernization opportunities.
  • Identify jurisdiction-specific needs for Jurisdiction K and Jurisdiction 6, including configuration, business rules, data and testing.
  • Coordinate with Wellpoint Federal teams and, as authorized, CMS and the Claims Core platform vendor to clarify functionality, interfaces, dependencies and open questions.
  • Partner with QA to define functional, integration, negative, regression and legacy/Claims Core coexistence test scenarios.
  • Maintain analysis artifacts, decisions, dependencies and work items in Wellpoint Federal-approved Agile tools, including JIRA.
  • Support documentation, knowledge transfer and implementation readiness for subsequent engineering work.
  • Compare current and proposed systems; identify functional, technical, operational, and security gaps. Support evaluation of refactoring, and replacement options. Document dependencies, constraints, business impacts, risks.
  • Create current-state and future-state process maps, system context diagrams, data-flow diagrams, sequence diagrams, and entity-relationship models.
  • Explain system boundaries, integrations, exception paths, and changes to user workflows clearly to both technical and business audiences., * Validated application/process inventory and dependency maps.
  • Current-state process and integration documentation, including known gaps.
  • Future-state requirements, workflow recommendations, user stories and acceptance criteria.
  • Impact assessment, technical dependency register and prioritized implementation-ready work packages.
  • Test scenarios, traceability and handover documentation.

Requirements

  • Strong experience as a senior systems analyst or business systems analyst supporting complex enterprise applications and integrations.
  • Experience with current-state discovery, business process mapping, functional specifications, user stories, acceptance criteria and requirements traceability.
  • Ability to analyze APIs, data exchanges, system dependencies, batch processes and operational workflows with technical and business stakeholders.
  • Working knowledge of application modernization, API-first design and integration concepts. Experience supporting Agile delivery, JIRA, testing and cross-functional technical coordination.
  • Strong written communication and ability to produce clear documentation where legacy specifications are incomplete., * Medicare claims processing or healthcare payer operations experience, especially Part A/Part B, MAC operations, FISS, MCS or CWF.
  • Exposure to EDI transactions, claims edits/adjustments, operational workflows and reporting.
  • Familiarity with REST APIs, MuleSoft, Python-based integrations and React-based user interfaces.
  • Experience with legacy-to-modern platform transitions, coexistence and data reconciliation.

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